Commissioning to put GP income at risk

Dr Smith: 'some element of existing GP income will be top-sliced' (Photograph: NTI)

Reform of the GP contract will also mean practices that do not take part in commissioning will lose income, sources close to the Conservative party say.

Plans for the premium, which will be paid to consortia for improving outcomes and maintaining financial control, were set out in a DoH consultation on GP commissioning last week.

National Association of Primary Care vice-president Dr Peter Smith said it was 'quite clear' there would be no new money for quality premiums.

'It's likely some element of existing GP income will be top-sliced,' he said. 'Whether it is part of the QOF will have to be negotiated with the GPC.'

Dr Paul Charlson, chairman of the Conservative Medical Association, expects the proportion of income practices receive through QOF to drop and those who do not commission to be punished financially.

'If people don't want to commission there will be some form of financial loss,' he said.

The DoH consultation says it will be up to consortia to distribute the quality premium to member practices. Dr Charlson said this will inevitably cause 'friction' between practices.

'The real point of this is to have a bit of peer pressure. If a practice is not performing, and does not pull its socks up, why should it get a share of this?

'For some that is going to cause friction. But if everyone else is putting in the effort, you have to make sure you do too.'

GPC negotiator Dr Chaand Nagpaul said the GPC is 'not looking for this to be a money-earner for practices' but said it would not accept GPs 'working harder for less money'.

GP consortia will be paid a basic management fee - separate from the quality premium - for commissioning.

But Dr Smith called for the £3 billion set aside by the DoH for service transformation this year to be made available to GPs now. The cash would help GPs set up consortia and ensure the process was not dominated by those involved in practice-based commissioning (PBC), he said.

'We don't know that people from PBC groups are the right people to be in charge,' he said.

The GPC has begun work on its response to the consultation but has seen little detail about how the incentive scheme will work, said Dr Nagpaul.